The nurse is caring for a client with acute renal failure. The most serious complication for this client is:
1
Anemia
2
Infection
3
Weight
... [Show More] loss
4
Platelet dysfunction - ANSWER 2
Infection
Infection is responsible for one third of the traumatic or surgically induced deaths of clients with acute renal failure, as well as for medically induced acute renal failure.
A client who had a suprapubic prostatectomy returns from the post-anesthesia care unit and accidentally pulls out the urethral catheter. What should the nurse do first?
1
Reinsert a new catheter.
2
Notify the health care provider.
3
Check for bleeding by irrigating the suprapubic tube.
4
Take no immediate action if the suprapubic tube is draining. - ANSWER 2
Notify the health care provider.
The catheter must be reinserted by the health care provider to ensure bladder emptying, maintain pressure at the operative site, and prevent hemorrhage. Because of the danger of further trauma to the urethra and surgical site, the health care provider should insert the catheter.
A client experiences difficulty in voiding after an indwelling urinary catheter is removed. The nurse determines that this difficulty most likely is related to:
1
Fluid imbalance
2
Sedentary lifestyle
3
Interruption in previous voiding habits
4
Nervous tension following the procedure - ANSWER 3
Interruption in previous voiding habits
An indwelling catheter dilates the urinary sphincters, keeps the bladder empty, and short-circuits the reflex mechanism based on bladder distention. When the catheter is removed, the body must adapt to functioning once again.
During discharge teaching, a client with an ileal conduit asks how frequently the urine pouch should be emptied. The best reply by the nurse is:
1
"To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours."
2
"To prevent skin irritation, it should be emptied every hour if any urine has collected in the bag."
3
"To reduce the risk of infection, the system should be opened as little as possible; two times a day is adequate."
4
"To reduce the cost of drainage pouches, it should be emptied once the system is switched to a bedside collection bag." - ANSWER 1
"To prevent leakage and pulling of the pouch from the skin, it should be emptied every few hours." [Show Less]